Nursing Development in Indonesia: Colonialism, After Independence and Nursing act

A survey of Indonesian nurses' educational experiences and self-perceived capability to care for people with intellectual disability and/or autism spectrum disorder

AIMS

To describe Indonesian nurses' educational experience regarding care for people with intellectual disability and/or autism and to explore if these educational experiences are associated with their self-perceived confidence, comfort, knowledge and preparedness to care for these cohorts.

DESIGN

Cross-sectional descriptive survey.

METHODS

A descriptive survey tool utilized in a study of Australian registered nurses was replicated and adapted for this study. Following descriptive analysis, chi-square analyses were undertaken to explore associations between educational experiences, and self-rated measures of confidence, comfort and knowledge to work with people with intellectual disability and/or autism. Although there was no end-user involvement in the design of the study, the concepts explored have all been raised by those with lived insights of intellectual disability and/or autism as being critical to their healthcare experiences.

RESULTS

There were 544 complete responses, and 51.7% were not exposed to any educational or clinical content relevant to caring for people with intellectual disability and/or autism. Moderate to low levels of self-perceived confidence, comfort, knowledge and preparedness to address healthcare needs of these cohorts were reported. Significant associations were identified between educational and clinical experiences during undergraduate training, and higher levels of self-perceived confidence, comfort and knowledge.

CONCLUSION

Mirroring international literature, the findings of this study highlight a large proportion of Indonesian nurses had little educational experience relevant to caring for people with intellectual disability and/or autism, and have relatively low levels of self-reported capability.

IMPACT

This study highlights gaps in the educational experiences, and self-perceived confidence, comfort, knowledge and preparedness of Indonesian nurses regarding caring for people with intellectual disability and/or autism. Given that internationally, people with intellectual disability and/or autism have disproportionately negative health outcomes and experiences, these findings have substantial implications for nursing curriculum, policy and professional development.

Indonesian nurses' awareness and application of reasonable adjustments when caring for people with intellectual disability and/or autism

AIM

This study aimed to understand Indonesian nurses' familiarity with the concept of reasonable adjustments, and the frequency of its application within their practice.

BACKGROUND

People with intellectual disability and/or autism are exposed to significant barriers when accessing healthcare and have poorer health outcomes than those without developmental disabilities. Reasonable adjustments can improve accessibility and quality of healthcare for people with disabilities and involves adapting practices and environments to promote equitable healthcare.

INTRODUCTION

There is a scarcity of literature focused on the application of reasonable adjustments in the Indonesian nursing context. A greater understanding of the application of reasonable adjustments in this context can help inform nursing curricula and policy.

METHODS

A cross-sectional, descriptive survey -was undertaken and is reported in accordance with the Strengthening the Reporting of Evaluations and Non-randomised Designs. Following descriptive analysis, bivariate analyses were undertaken between key demographic, workplace, and self-reported capability variables, and familiarity and implementation of reasonable adjustments.

RESULTS

The majority of respondents were not familiar with the concept of reasonable adjustments and self-reported sometimes applying it within their practice. Higher levels of educational and clinical exposure to intellectual disability and/or autism, and self-capability variables, were significantly associated with familiarity with reasonable adjustments and their application.

CONCLUSIONS

An increase in nursing curricula focused on caring for people with intellectual disability and/or autism, including content focused on applying reasonable adjustments, is indicated.

IMPLICATIONS FOR NURSING POLICY

Given that, internationally, people with intellectual disability and/or autism have disproportionately negative health outcomes and experiences, findings highlighting gaps in understanding and application of reasonable adjustments of Indonesian nurses have substantial implications for nursing policy and curriculum.

Nurses' and nursing students' reasons for entering the profession: content analysis of open-ended questions

BACKGROUND

Global nursing shortages require effective recruitment strategies and understanding of individuals' motivations to enter the profession. These can be complex and bound by numerous factors such as gender and culture. While much research around this has been conducted, little has been undertaken in non-Western cultures where motivations could be different.

AIM

To explore Indonesian nurses' and nursing students' motivations for entering the nursing profession.

DESIGN

Online survey with closed and open-ended questions drawn from two different studies. This paper reports findings from one similar open-ended question.

METHODS

As part of two larger surveys, nurses from 13 hospitals across one private health care group and nursing students with clinical experienced enrolled in a baccalaureate nursing program in Indonesia were asked the question, Why do you want to be a nurse? Responses were translated into English and back-translated into Indonesian prior to being subjected to summative content analysis.

RESULTS

In total, 1351 nurses and 400 students provided responses to the question, representing 98.72% and 99.70% respectively of those completing the survey. Both groups were primarily influenced by desire to serve others and God, personal calling and influence of family members and others. Nurses identified a desire to work in the health field and with the sick, in a noble and caring profession.

CONCLUSIONS

Nurses and nursing students were motivated by traditional perspectives on nursing. These should be considered in future recruitment activities. However, more research is needed to understand how these factors influence career choice.

Strategies and challenges in addressing ethical issues in the hospital context: A phenomenological study of nurse team leaders

Background

Nurse team leaders encounter considerable ethical challenges that necessitate using effective strategies to overcome them. However, there is a lack of research exploring the experiences of nurse team leaders in Indonesia who face ethical dilemmas in their professional duties.

Objective

This study aimed to explore nurse team leaders' experiences regarding strategies and challenges in dealing with ethical problems in hospital settings in Indonesia.

Methods

This qualitative study employed a hermeneutic phenomenology design. Online semi-structured interviews were conducted between November 2021 and February 2022 among 14 nurse team leaders selected using a snowball sampling from seven hospitals (three public and four private hospitals). Van Manen's approach was used for data analysis.

Results

The strategies for overcoming ethical dilemmas included (i) seeking the facts, (ii) stepping back, (iii) considering support, and (iv) standing by patients. The challenges for the nurse team leaders in resolving ethical problems consisted of (i) seniority, (ii) trust issue, and (iii) lack of reflection and ethics training.

Conclusion

Nurse team leaders recognize their specific roles in the midst of ethical challenges and seek strategies to deal with them. However, a negative working environment might impact ethical behavior and compromise the provision of quality care. Therefore, it is imperative for hospital management to take note of these findings and address issues related to seniority by providing regular ethics training and group reflection sessions to maintain nurses' ethical knowledge in hospital practice. Such interventions can support nurse team leaders in resolving ethical dilemmas and provide a conducive environment for ethical decision-making, ultimately improving patient outcomes.

Development of contextual learning models through collaboration between lecturers, students, and village governments in nursing education

PURPOSE

This study aims to develop a contextual learning model through a collaboration between lecturers, students, and the village government for nursing education.

METHODS

This study used a qualitative design. The process of collecting the data was done through focus group discussions with 12 informants representing four stakeholders. There were four focus groups, namely universities, village governments, community health centers, and students. The discussion used open-ended questions that were developed through two parameters, the learning outcomes and learning activities. The data analysis undertaken used thematic analysis specifically.

RESULTS

There were 11 grouped concepts found in this study which were able to be divided into three categories. The learning outcome category was formed of four concepts, including attitudes, mastery of knowledge, skills, and values. The learning process category was formed of five concepts, namely learning resources, learning methods and forms, learning media, learning time, and learning subjects. The main sources of contextual learning were found to be programs and maternal and child health (MCH) issues in the village. Techniques and instruments were the two concepts in the assessment category. A collaboration between lecturers and the village government to help students and to provide learning resources in the village integrates the program (MCH) with the learning outcomes.

CONCLUSION

These concepts are the initial framework to help the head of the study program to integrate the MCH programs and cases in the curriculum and to facilitate the contextualization of the knowledge from the nursing students.

Development of blended learning model integrated nursing leadership training using web-based in Indonesia

BACKGROUND

Nurse managers are the frontline leaders in the ward that directly impact the quality of care services. Many nurse managers in Indonesia were inadequately prepared to fulfill this role, especially during this crisis. The objective was to develop blended learning an Integrated Nursing Leadership Training (INLeT) using web based and test the effectiveness.

MATERIALS AND METHODS

This research is a research development using modified Borg and Gall by researcher, namely, Planning, Redesign, Intervention, Modify, and Evaluation. The INLET model was validated by nine experts in health and media technology design. Data were tested using quasi-experiment research in Sanglah General Hospital and Wangaya Public Hospital in Bali.

RESULTS

The results of analysis of the content validity of all items valued V index 0.96 (high category) from design experts and V Index 0.92 (high category from health experts. The experiment group obtained N Gain scored 0.5603 at medium level, and the control group result of N Gain Score was 0.2845 in the low-level category. Using t-test, both the experiment and control group showed significant improvement of score test with P = 0.000 (P < 0.005). Bivariate analysis using independent t-test result P = 0.000 (P < 0.005) means significant difference score test compared between experiment and control group.

CONCLUSIONS

Using the web, this blended learning INLeT Model is effectively applied for nurse manager professional development; therefore, this study can prepare nurse managers into a leadership role by integrating moodle web-based into nursing training.

Benefits and Challenges of Clinical Nurse Educator Roles: A Qualitative Exploratory Study

BACKGROUND: The nurse will successfully apply high quality of care if maintaining their comptencies. The quality of nursing care is dynamic, and competency is needed to be adapted. Besides, The presence of clinical nurse educator (CNE) able to strengthen nurses’ knowledge and skill in the clinical setting. AIM: This study aimed to explore the benefits and challenges of CNEs. METHODS: A qualitative exploratory design was used in this study. Data were collected by focus group discussion with eight CNEs at Sanglah General Hospital Bali. Content analysis was used for analyzing the data. RESULTS: The findings of this study suggest certain advantages for the hospital, such as continuing professional education and becoming a role model. Greater incentive to learn, as well as personal rewards such as increased self-confidence, being appreciated, and trust. A lack of support from management related to educational preparation for this function, the ambiguous role, the necessity to continue giving direct care, and the CNE ratio with the number of nurses is not equal were some of the challenges that arose. CONCLUSION: CNEs serve a critical role in the clinical context. They help nurses with ongoing education and competency maintenance. While numerous excellent outcomes have developed for hospitals and CNEs personally, many of them confront several obstacles in fulfilling their work properly.